The Insulin Crisis: A Deadly Consequence of Medical Price Gouging

By Hannah B., Lagniappe Wellness Dietetic Intern

Over 31% of people with diabetes are prescribed daily insulin injections

The Humble Origin of Insulin

In 1921, Canadian medical scientist and physician Fredrick Banting discovered what would be known as the most significant medical invention of all time (NATAP, n.d.). His breakthrough research would enable insulin to be extracted from various animals to be used therapeutically for individuals with diabetes. Insulin is a peptide hormone that aids in carbohydrate metabolism by allowing glucose uptake into cells. Prior to the discovery of insulin therapy, those with type 1 diabetes were given a life expectancy of three years. Banting sold the patent for insulin to the University of Toronto for just $1 to become affordable and accessible to the masses. The physician thought it unethical to profit from a therapy that could save lives. Despite its charitable origins, insulin has become a prime example of medical price gouging, making this life-saving medicine less accessible to those in need.  


An early model of clinically used insulin (Iletin) in its original packaging (Wendt, 2013).

The National Cost of Diabetes

The CDC 2020 National Diabetes Statistic Report found that over 1 in 10 Americans (34.2 million) have diabetes. This staggering statistic indicates that a significant proportion of the American population relies on medical intervention for blood sugar management. Among these interventions is insulin, which will have its 100th anniversary for human clinical use in January 2022. Diabetes costs the United States more than $327 billion per year with the many intensive medical therapies for blood sugar management and diabetes-related complications (Cefalu et. al, 2018). Without proper management, diabetes can result in complications including neuropathy, kidney disease, retinopathy, poor wound healing, and cardiovascular disease.

The Deadly Cost of Price Gouging

The price of insulin has skyrocketed over time. The Healthcare Cost Institute reports a rise in the annual cost of insulin from $2,864 in 2012 to $5,705 in 2016 (NATAP, n.d.). With just three major companies controlling 96% of the global insulin market, the price of insulin has become severely gouged (Cefalu et. al, 2018). These pharmaceutical manufacturers can produce a vial of insulin for just a fraction of the average market price. Regardless of the increased awareness, the cost of diabetes-related medications continues to rise.

Rising list prices of diabetes medications and supplies from 2014 to 2019 (Mui, 2019).

This high cost may deter many from following an appropriate insulin therapy regimen, leading some to split or skip doses to ration their insulin (Commonwealth, 2020). Insufficient insulin can lead to diabetic ketoacidosis: a severe and sometimes fatal complication of diabetes occurring with inadequate insulin. Thirteen deaths occurred between 2017 and 2019 from insulin rationing due to lack of accessibility and affordability. The price gouging of insulin has become a deadly consequence of big pharma that Banting worked hard to avoid. 

A Solution for the Insulin Crisis

In recent years, the struggle of insulin affordability has gained traction in many journals and news outlets. The price gouging of insulin keeps those who struggle to afford their medications at acute risk of death (Battino, 2019). This now calls into question the responsibility and morality of our current healthcare system. How can we deny Americans access to life-saving medical treatment?

There are several proposed solutions to the extreme prices. Eli Lily, a major manufacturer of medical insulin, announced plans to produce a generic form of original medicine at half price (Battino, 2019). Although a step in the right direction, the list price of $137.35 will still pose a burden to many American families. The creation of generic forms of these medications becomes complicated by patents and allows for the monopolization of pharmaceuticals. Granting the FDA and other pharmaceutical companies permission to develop quality off-patent forms of these medications is an essential next step in responding to this insulin crisis. Another solution is to create reforms that block the increase in the list price of drugs unrelated to increased production cost or cap out-of-pocket spending (HCCI, 2021).

Many healthcare providers and patient advocates are beginning to respond to the plea of a financially burdened population. There is a moral struggle amongst these medical representatives about where the responsibility falls and how to control the pharmaceutical market without setting dangerous precedents. The bottom line remains: consumers need access to affordable insulin. As Frederick Banting once said, “insulin does not belong to me, it belongs to the world.” Although insulin therapy has changed the world, we have strayed far from his vision for this 1921 invention.

References

“The Absurdly High Cost of Insulin” – as High as $350 a Bottle, Often 2 Bottles per Month Needed by Diabetics, https://www.natap.org/2019/HIV/052819_02.htm. 

Battino, Gabby. “Policy Solutions to Address the Rising Cost of Insulin.” NCHC, 21 July 2020, https://nchc.org/policy-solutions-to-address-the-rising-cost-of-insulin/. 

“Capping out-of-Pocket Spending on Insulin Would Lower Costs for a Substantial Proportion of Commercially Insured Individuals.” HCCI, https://healthcostinstitute.org/hcci-research/capping-out-of-pocket-spending-on-insulin-would-lower-costs-for-a-substantial-proportion-of-commercially-insured-individuals-1. 

Cefalu, William T., et al. “Insulin Access and Affordability Working Group: Conclusions and Recommendations.” Diabetes Care, vol. 41, no. 6, 2018, pp. 1299–1311., https://doi.org/10.2337/dci18-0019. 

Mui, K. (2019). Diabetes Medications and Supplies. The GoodRx List Price Index Reveals the Rising Cost of All Diabetes Treatments – Not Just Insulin. Good RX. Retrieved December 12, 2021, from https://www.goodrx.com/healthcare-access/research/goodrx-list-price-index-rising-cost-of-diabetes-treatments. 

Mulcahy, Andrew, et al. “Comparing Insulin Prices in the United States to Other Countries: Results from a Price Index Analysis.” 2020, https://doi.org/10.7249/rra788-1. 

“National Diabetes Statistics Report, 2020.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 11 Feb. 2020, https://www.cdc.gov/diabetes/library/features/diabetes-stat-report.html. 

“Not so Sweet: Insulin Affordability over Time.” Commonwealth Fund, https://www.commonwealthfund.org/publications/issue-briefs/2020/sep/not-so-sweet-insulin-affordability-over-time. 

Wendt, D. (2013). A bottle of 1920s Iletin (Lilly insulin), which is the finished product seen below being labeled and packaged. Two tons of pig parts: Making insulin in the 1920s. National Museum of American History Behring Center. Retrieved December 12, 2021, from https://americanhistory.si.edu/blog/2013/11/two-tons-of-pig-parts-making-insulin-in-the-1920s.html. Rajkumar, S. Vincent. “The High Cost of Insulin in the United States: An Urgent Call to Action.” Mayo Clinic Proceedings, vol. 95, no. 1, 2020, pp. 22–28., https://doi.org/10.1016/j.mayocp.2019.11.013.

Diabetes drugs for Obese Individuals  with Type 1 Diabetes

By: Ivette L., LW Dietetic Intern

         When it comes to people with diabetes, folks assume all are type 2 and it is associated with old age and/or excess weight. While this observation is not wrong, it is quite far from the entire picture. There is actually more than one type of diabetes, but in order to understand them, let’s begin with what diabetes actually is. Diabetes is defined as, “a disease where the body cannot make or doesn’t make enough insulin (a pancreatic hormone) resulting in high blood sugar in the bloodstream.” Type 2 diabetes, the most recognized form, is a condition where the body isn’t producing enough insulin or is insulin resistant causing high blood sugar (hyperglycemia). It normally occurs in adults but can affect children. It is also preventable. Similar to type 2, there is gestational diabetes which only develops during pregnancy. Pregnant women are usually tested between 24-28 weeks. Gestational diabetes should go away after giving birth but increases odds of developing type 2 diabetes in the future. (CDC 2020)

Type 1 diabetes, which is less common and therefore often misunderstood, is an autoimmune disease during which your body does not produce ANY insulin. It is formerly known as juvenile diabetes but can be diagnosed at any age. Unfortunately, there is no research on prevention. Currently, the only approved medical treatment for type 1 diabetes is insulin therapy consisting of a combination of short or fast acting and intermediate, or long-acting that is administered via a syringe, pen, or through an insulin pump. Newer insulins include Afrezza which is an inhalable fast acting insulin. The only permitted alternate medication is the oldest type 2 medication, metformin, or Symlin (injectable anti-diabetic medication that acts like a hormone to lower blood sugar) combined with insulin. (Janssens, Caerels & Mathieu 2020)

Everyone thinks they can tell type 1 from type 2 if the person is overweight. The heavier ones are people with type 2 diabetes, and the type 1’s are leaner. However, recent research is demonstrating that this isn’t always the case. Over 50% of people with type 1 diabetes are now in the obese category. Excess body weight is linked to inconsistent blood sugar levels, overcorrection of low blood sugar episodes, unhealthy diet, and lack of physical activity. It can lead to increased risk of insulin resistance, cardiovascular disease, chronic kidney disease, and other diabetes related complications. In recent years, a term known as “off label use” has been applied to diabetes care. This occurs when medications used and approved to treat one thing are prescribed to treat another condition. In this case, the off label drugs are the type 2 diabetes medications that are being used to treat type 1 diabetes. The latest drugs being used are: SGLT-2 inhibitors (sodium-glucose cotransporter-2 Inhibitors). Some known examples are Invokana, Jardiance, and Farxiga. In Europe, this is a widely used practice as it has been officially approved there. Unfortunately for Americans, the FDA has not authorized  the use of SGLT-2 inhibitors for type 1 diabetes. (Hage et al 2019)

How do SLGT-2 inhibitors help people with type 1 diabetes anyway? The medication, in pill form, blocks the SGLT-2’s (transport proteins in the kidneys) ability to trap sugar, or glucose, in the bloodstream and is instead filtered out of the kidneys leaving the body in our urine. This then lowers A1C levels, requires less insulin, increases insulin sensitivity, and decreases chances of cardiovascular disease. Another useful bonus is that it produces weight loss. The idea is that by losing all that sugar that comes from the food we eat, we are cutting down our calorie intake. (Janssens, Caerels & Mathieu 2020)

This all sounds so incredible and easy so why aren’t endocrinologists running to call all of their patients with type 1 diabetes who may be overweight and insulin resistant? For one, there simply isn’t enough research for doctors to determine if it’s safe enough to prescribe. Secondly, despite the wonderful benefits discussed here, there are concerning side effects. The biggest concern is that usually when a person with type 1 diabetes also takes a type 2 medication like Invokana or Farxiga, they are more likely to get DKA which for any person with diabetes that you ask is their absolute worst nightmare. 

Diabetic ketoacidosis , DKA, develops when your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy. Your energy deprived body tries to get fuel from the liver. When the liver breaks down the fat in order to make energy, it produces an acid in your blood. When this goes on for a prolonged time, the acidic buildup in your blood becomes a very risky situation. Think of insulin as the key needed to unlock your blood cells to let the sugar in. You can force open with another key but this can only work for so long. (Meena 2020)

SLGT-2  inhibitors tend to cause euglycemic DKA which is like a sneaky and deceptive type of DKA. It is DKA but with blood sugar numbers under 250. Euglycemic DKA is more dangerous because it can be hard to detect if you’re only testing your blood sugars. This is why it is so important to watch out for other telltale signs such as vomiting, lethargy, large amounts of ketones in the urine, and extreme thirst. Euglycemic DKA is rare and typically only happens to people with type 1 diabetes using SLGT-2 inhibitors.(Meena 2020) Because the medication is causing you to release excess sugar through your urine, it tricks your body into thinking it needs less insulin, when our bodies require insulin 24/7 in order to stabilize our blood sugars. So you can have what you think are “decent” blood sugars and your body still needs more insulin! Other possible side effects include frequent urinary tract infections due to excessive urination and hypoglycemic (low blood sugar) episodes. (Geerlings et al 2014)

Now to the question of the hour, is it worth the risk? Depends. As a person with diabetes for over 20 years who also happens to be insulin resistant and obese, my endocrinologist has suggested SLGT-2 inhibitors several times. While it’s an unconventional treatment, my doctor is confident it will help bring down my blood sugars, reduce my overall insulin requirements, and help me lose some weight. I’ve resisted because of the intense fear of euglycemic DKA. Luckily, I’ve never experienced ketoacidosis, but from what other fellow T1Ds have said, it’s horrible. Because of my hectic lifestyle with grad school, work, and my dietetic internship, I preferred to wait until I had more time to closely monitor myself for any signs of euglycemic DKA. Now that I am done with grad school, I will begin using Invokana with my insulin pump. Am I scared? Yes, but after having done the research and trying the traditional method of increasing physical activity, I am willing to cautiously forge ahead. That being said, I wouldn’t recommend it to all  people with type 1 diabetes. If you are able to lose weight the old-fashioned way and are NOT significantly insulin resistant, I would caution against it and stick to what we know works for us. It requires additional planning and discipline. If you are someone who may not be able to handle the added stress of having yet another diabetes red flag to watch out for, then maybe reconsider. After all, we cannot forget that these medications were not intended to treat type 1 diabetes.

References 

Geerlings, S., Fonseca, V., Castro-Diaz, D., List, J., & Parikh, S. (2014). Genital and urinary tract infections in diabetes: Impact of pharmacologically-induced glucosuria. Diabetes Research and Clinical Practice, 103(3), 373-381. doi:10.1016/j.diabres.2013.12.052

Hage, L. E., Kashyap, S. R., & Rao, P. (2019). Use of SGLT-2 Inhibitors in Patients With Type 1 Diabetes Mellitus. Journal of Primary Care & Community Health, 10, 215013271989518. doi:10.1177/2150132719895188

Janssens, B., Caerels, S., & Mathieu, C. (2020). SGLT inhibitors in type 1 diabetes: Weighing efficacy and side effects. Therapeutic Advances in Endocrinology and Metabolism, 11, 204201882093854. doi:10.1177/2042018820938545

Meena, P., MD. (2020, September 14). SGLT2 Inhibitor-induced Euglycemic Diabetic Ketoacidosis. Retrieved October 9, 2020, from https://www.renalfellow.org/2020/09/08/sglt2-inhibitor-induced-euglycemic-diabetic-ketoacidosis/

What is diabetes? (2020, June 11). Retrieved October 8, 2020, from  https://www.cdc.gov/diabetes/basics/diabetes.html

Tackling Celiac in the World of Someone with Type 1 Diabetes

By: Laura B., LWDI Intern

Hello! My name is Laura B. In my free time, I enjoy riding on my brother’s boat, fishing, listening to music, walking 5ks with my mom, and spending time with my family including my dog Kelly.  I was diagnosed with T1D in April 2000 and wow has it been a long roller coaster of emotions and highs and lows since then. Having T1D for as long as I have, I have learned and grown a lot from my experiences. I am currently on a Tandem t-slim X2 pump, and I have a Dexcom sensor to monitor my blood sugars. In 2020, when my diabetes management was at its best, my world got flipped around with an additional diagnosis of Celiac Disease. Living with Celiac has taught me a lot about my body and how to listen to it to stay healthy.  I have used my time with T1D and my short time with Celiac to explore some good, healthy recipes along with some snacks to enjoy. While my diagnoses have been really hard on me over the years, I have enjoyed using them to meet new people, grow in life, and expand my understanding of food and my body.  

Type 1 Diabetes (T1D) is a chronic condition in which the pancreas produces little or no insulin.  Insulin is a hormone needed to allow sugar (glucose) to enter cells and produce energy; therefore, people with T1D must manually inject insulin.  Type 1 is usually diagnosed in children, but it can occur at any age. I was diagnosed with T1D at age three, 21 years ago. As if living with T1D was not hard enough, I was also diagnosed with Celiac Disease in 2020. Celiac Disease is a serious autoimmune disease that occurs in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine which can affect the ability of the gut to absorb nutrients resulting in nutritional deficiencies.  Unfortunately, a person with T1D is significantly more susceptible to Celiac as well because they are both autoimmune diseases (Meadows 2014) .

There is currently no cure for T1D or for Celiac Disease, so the only thing that can be done is to manage it. For T1D that includes taking insulin and testing your blood sugar every time you eat; however, the only management for Celiac is a gluten-free diet (GFD), so the intestine can repair itself. As one could imagine, managing both of these conditions at the same time can be very difficult because they both revolve around the diet, and they require a different set of rules on what can and cannot be eaten. Having a combination diagnosis like this can be very daunting in the beginning, but it becomes second nature once you do it long enough. So what should someone with a combination diagnosis of T1D and Celiac Disease eat? The best place to start is to understand each condition separately before trying to manage the diets of these conditions at the same time. 

Being a person with T1D and Celiac Disease does not mean you cannot eat the things you love ever again; however, you will have to make adjustments. Many of the nutrition intake recommendations for T1D are consistent with the recommendations for the general public; however, there are still some slight changes because carbohydrates significantly affect the blood sugar of a person with T1D. The diet for someone with T1D should consist of carbohydrates from fruits, vegetables, whole grains, legumes (beans, peas, nuts, etc.), lean meats, and low-fat milk to have the best success with blood glucose control (Delahanty 2021). While carbohydrates should come from fruits, they should not come from fruit juice because juices contain a large amount of sugar. As a result, people with T1D should avoid sugar-sweetened beverages altogether. The diet should also be low in sodium, high in fiber, and contain high quality proteins. 

I have often encountered people who think that as a person with T1D, I should never eat any sugar.  It is much more complicated than that because your body needs sugar to function. Foods consumed get converted to sugar (glucose), regardless of the source; therefore, it is more important to know what kind of sugar you are consuming and to get it from sources that actually benefit your health.  However, it does not mean you can never ever eat a small slice of cake ever again. It is also important to realize that all people with T1D are not affected in the same way by certain foods. As a result, a T1D diet can be a bit of trial and error. Carb counting is vital to a person with diabetes. In a study done to see the impact of a low carb diet in people with T1D, it was shown that a diet with 70-90 g of carbs per day is beneficial in lowering blood sugars overall without causing health problems like hypoglycemia, etc. (Nielsen et al 2005).

 

Insulin improvements and technology advancements have revolutionized diabetes management, but have not eliminated the need to focus on a good diet. Counting carbs, with the help of nutrition labels, is essential to maintaining healthy glucose levels.  But there are additional factors to consider when dealing with Celiac as well. Now not only will you be looking at food labels for carb info, you will also be looking for ingredients that contain gluten. 

Diabetes distress is a real thing that occurs in people with T1D, and is often triggered by the overwhelming number of food choices to make and the sense of defeat when your glucose levels are not good.  The additional complication of Celiac can add to that overwhelming frustration, so it is important to get help when you feel too stressed about your condition or the things going on in your life. 

 Since Celiac Disease is a condition in which the individual is impacted by gluten intake, the first step in a Celiac diagnosis is to cut out gluten altogether and go on a gluten-free diet (GFD). Gluten is found in products with wheat, barley, and rye, so it is very important to stay diligent in food label and ingredient list reading (Basina 2020.). I was lucky that at the time of my diagnosis, I had just finished my undergrad in dietetics, so I knew what gluten was and how many food choices would be affected. However, I could also understand how overwhelming it could be for someone who did not know what gluten was. When I was first told of the risks of eating gluten, I fell into a puddle of tears because I love pasta, pizza, rolls, and an occasional piece of cake. It is easy to focus on what you will lose.  However, the technology and food science developments over the years have made it significantly easier for individuals with Celiac to find many replacements of these things and still enjoy them.

 

The best way to live a happy and healthy life with Celiac Disease is to consume foods that are naturally GF. Some of the foods in this category are fruits, vegetables, meat and poultry, fish and seafood, dairy, beans, legumes, and nuts (Celiac Disease Foundation n.d.). These are also good choices for a person with T1D. It will be hard at first to adapt and feel okay with your diagnosis, but it will get easier. It may take a lot of trial and error to find what foods you like and which ones you do not, but there are many good GF alternative foods out there worth trying. I encourage all people with Celiac to branch out and take this moment to try new things because that will be key in your journey with Celiac. One of my favorite meals for breakfast before Celiac was peanut butter and banana toast with a glass of milk, and I was afraid I would not be able to enjoy that anymore. However, I found gluten free bread and all the other ingredients are naturally GF, so I was able to continue enjoying one of my favorite breakfast treats. Look at the things you love to eat as opportunities to explore and find the GF alternatives, or replace them with healthier, naturally gluten free options. 

It can be hard enough to manage just Celiac Disease, but the factor of adding T1D on top of that can be exhausting. Foods that contain large amounts of gluten also have a lot of carbs and sugar in them, which is unhealthy for people with T1D and people with Celiac. The good thing is, there is a huge overlap between which foods are naturally GF and which foods are good to eat if you have T1D (“How Gluten Intake is Linked to Type 1 Diabetes” 2020).

Healthy choices for a person with T1D and Celiac include a lot of fruits, vegetables, fresh meat and seafood, and dairy products. As there can be many harmful side effects to not adhering to a GFD when you have Celiac Disease and many extremely harmful side effects to not taking your insulin and counting carbs correctly with T1D, it is vital that people with both of these conditions strictly monitor their food intake to keep themselves happy and healthy. Below are some recipes that I have found to be very delicious and have all GF ingredients! It is important to get help if you feel overwhelmed with the burden of having to care for yourself with 2 very tiring and time consuming conditions like T1D and Celiac Disease. I know for myself, it has been super helpful having friends, family, and a third-party to talk to when things get to be too much with my conditions. I hope you are able to find someone like that in your life to help be that rock for you. If not, I am always here to help and answer any questions you have that I can answer on this topic. It’s so important to know that you are loved and while you may be unique, you can do anything you set your mind to even if you have both Celiac Disease and T1D. Don’t let your conditions stop you from following your dreams and doing what you love, I sure know I have not. Good luck, and you got this!!

GF Green Bean Casserole: https://www.bettycrocker.com/recipes/gluten-free-green-bean-casserole-with-fried-onions/74dac433-d6db-46c1-9003-6d7a4d5c03b7

GF Tater Tot Bacon Cheeseburger Casserole: https://www.mamagourmand.com/cheeseburger-casserole/

GF oreo Truffles: https://www.whattheforkfoodblog.com/2014/12/03/gluten-free-oreo-truffles/

Eat This, Not That! GF recipes: https://www.eatthis.com/weeknight-gluten-free/

References

Meadows, K. (2014, January). Living gluten free with type 1 diabetes. Today’s Dietitian. Retrieved February 18, 2022, from https://www.todaysdietitian.com/newarchives/010614p34.shtml 

Delahanty, L. M. (2021, June 15). Patient education: Type 1 diabetes and diet (Beyond the Basics). UpToDate. Retrieved February 18, 2022, from https://www.uptodate.com/contents/type-1-diabetes-and-diet-beyond-the-basics 

Jørgen Vesti Nielsen, Eva Jönsson & Anette Ivarsson (2005) A Low Carbohydrate Diet in Type 1 Diabetes, Upsala Journal of Medical Sciences, 110:3, 267-273, DOI: 10.3109/2000-1967-074

Basina, M. (2020, October 7). T1D & celiac disease. Beyond Type 1. Retrieved February 18, 2022, from https://beyondtype1.org/celiac-disease/?gclid=Cj0KCQiA5aWOBhDMARIsAIXLlke3yURWVchA3SKU27oO4M0YIRPaGms6BMtECnlZallYtAuoZ55n2yoaAtZCEALw_wcB 

Meadows, K. (2014, January). Living gluten free with type 1 diabetes. Today’s Dietitian. Retrieved February 18, 2022, from https://www.todaysdietitian.com/newarchives/010614p34.shtml 

Gluten-free foods. Celiac Disease Foundation. (n.d.). Retrieved February 18, 2022, from https://celiac.org/gluten-free-living/gluten-free-foods/ 

How gluten intake is linked to type 1 diabetes. Byram Healthcare. (2020, January 15). Retrieved February 18, 2022, from https://www.byramhealthcare.com/blogs/how-gluten-intake-is-linked-to-type-1-diabetes 

Effects of a Low Carbohydrate and Ketogenic Diet on Type 2 Diabetes and Obesity

By: Lydia Parker, LWDI Intern

Effects of a Low Carbohydrate and Ketogenic Diet on Type 2 Diabetes and Obesity

When I look up “what is the best diet to be on” on Google, there are numerous nutrition programs such as Noom, Nutrisystem, and Weight Watchers that are suggested. However, diets such as Atkins, DASH, and the ketogenic diet also appear in the search. So, what really is the best diet? As I have been asked this question multiple times, my answer is different for each individual.

 Prescription form close-up

In my current outpatient rotation I am working alongside an obesity medicine physician who specializes in medical weight loss. On a day to day basis, appetite-suppressant medications are prescribed to help patients who are overweight or obese, lose weight and to reverse comorbid conditions like diabetes, hypertension, and fatty liver disease.

Although medication is considered one of the four pillars of the treatment of obesity, diet is another that has been researched for years due to its importance. The physician I work alongside stresses the importance of a low-carbohydrate diet or a ketogenic diet due to its effects on weight loss. A low-carbohydrate diet is defined as consuming less than 130g of carbohydrate a day whereas a ketogenic diet would be defined as consuming less than 50g of carbohydrate a day (1). The ketogenic diet as a whole consists of 70 to 80% from fat, 10 to 20% from protein, and 5 to 10% from carbohydrates (2). So what are the true benefits of a lower carbohydrate, or ketogenic diet and how does it work? 

Keto diet

In this kind of diet, the body enters a process known as ketosis. Ketosis occurs when the body produces ketones and fatty acids from the liver for its fuel source rather than using glucose. In using this alternate fuel source, a loss of fat is observed, thus resulting in overall weight loss and positive effects on individuals with type 2 diabetes as explained below.

In an article written by Athinarayanan et al called the “Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes”, researchers focused on the long-term effects of ketosis. Over the course of 2 years, they found that greater than 50% of patients following a very low carbohydrate diet were able to reverse type 2 diabetes, lose greater than 10% of their body weight, improve lab work such as hemoglobin A1C, fasting glucose, and triglycerides and also reduce dependence on medications like sulfonylureas and insulin (3). Additionally, another study was released where researchers followed individuals with type 2 diabetes on a ketogenic diet for 12 months. At the end of the twelve month period, greater than 50% of patients following the ketogenic diet reversed their diabetes, improved their lab values such as hemoglobin A1C, and reduced the number of medications they were on to none or only Metformin (1).

 Diabetes prevention

As any diet presents with difficulties and side effects, this one does as well. If an individual is following a low carbohydrate diet, they are less likely to experience more severe effects than those following a very low carbohydrate diet. It is typical to experience fatigue, lightheadedness, and weakness within the first few weeks in addition to muscle cramps, constipation, and even hypokalemia (4). With any restriction of carbohydrates, those prone to gout are at increased risk for having an arthritic attack. Later onset side effects include cholestasis, hair loss, and dry skin according to Vernon et al (4). On a positive note, many of these side effects can be prevented and relieved through simple fixes such as supplementation, medication, and increased fluid intake (4). For patients with diabetes, hypoglycemia is one of the biggest concerns for those following a keto or low carbohydrate diet. In the studies I have presented here, there were little to no hypoglycemic events reported (3, 5).

 Side Effects

As I mentioned previously, I truly do not believe one diet fits all. I have been studying nutrition for over 5 years now and have always been apprehensive about this diet due to the higher fat intake requirement to reach ketosis. However, in my current rotation and the research I’ve done about the keto diet and its effects on type 2 diabetes and obesity, I’ve been able to witness first-hand how effective and life-changing it is. I’ve seen many patients reverse their hypertension, diabetes, metabolic syndrome, and non-alcoholic fatty liver disease and even get off a number of medications by cutting out a majority of their carbohydrate intake. Although this diet can mean something different for everyone, the research is there and the patients are the evidence. 

I encourage you all to do your own research about nutrition topics before believing what you see in one singular piece of evidence. The internet is filled with so much information, and most often is difficult to tell right from wrong. Ask your providers, reach out to RD’s, and never be afraid to share what you learn. Knowledge is power! 

Keto Diet Foods

By: Lydia Parker, Lagniappe Wellness Dietetic Intern

References-

  1. Volek, J.S.; Phinney, S.D.; Krauss, R.M.; Johnson, R.J.; Saslow, L.R.; Gower, B.; Yancy, W.S., Jr.; King, J.C.; Hecht, F.M.; Teicholz, N.; et al. Alternative Dietary Patterns for Americans: Low-Carbohydrate Diets. Nutrients 2021,13,3299. https:// doi.org/10.3390/nu13103299
  2. Diet Review: Ketogenic Diet for Weight Loss, Harvard School of Public Health, The Nutrition Source. https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/ketogenic-diet/ 
  3. Athinarayanan, SJ; Adams, RN; Hallberg, SJ; McKenzie, AL; Bhanpuri, NH; Campbell, WW; Volek, JS; Phinney, SD; and McCarter, JP; et al (2019). Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial. Front. Endocrinol. 10:348. doi: 10.3389/fendo.2019.00348
  4. Vernon, MC; Westman, EC; Wortman, JA. Dietary Treatment of the Obese Individual. Obesity: Evaluation and Treatment Essentials, 2016. Dietary Treatment of the Obese Individual.
  5. Yancy, WS Jr; Foy M; Chaleck, AM; Vernon, MC; Westman, EC; et al. A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab (Lond). 2005;2:34. Published 2005 Dec 1. doi:10.1186/1743-7075-2-34

LWDI Intern Spotlight: Hannah A.

Check out the AMAZING work Hannah has been doing during her Food Service Rotation.  Way to go, Hannah!

The high school district I interned at hires a third party company, Chartwells, to handle a part of their food service operations. ‘Discovery Kitchen’ is something that Chartwells hosts throughout their schools. It was created to help promote healthy eating and nutritional education for all students, faculty, and parents. Due to the pandemic, they have newly added “Discovery Kitchen – At Home’ to involve the parents in learning about a healthy and happy kitchen. I was able to perform a ‘Discovery Kitchen’ at all 7 of the high schools within the school district. I helped create the recipe for sampling (caesar kale salad) as well as surveying and educating the students on the meal. Due to the positive feedback, the Director of Food Services let me know that they will be adding a variation of my salad to the school lunch menu next month – which was a great accomplishment! I was just invited by the Director to attend the Discovery Kitchen Board meeting to talk to all the Board members about my experience and answer any questions the Board may have!

LWDI Alum Spotlight: Virginia Leads a Pantry Garden to Surpass Goals and Supply over 850 lbs of Fresh Produce to a Community in Need

Recent graduate of LWDI, Virginia, started her journey as a Dietetic Intern with a food pantry in her area. She continues to serve her community by being a leader of the team that started this community garden at the pantry. The garden has surpassed their goal of 450 lbs and has provided over 850 lbs of fresh produce to their community in need!

We are so proud to see how Virginia’s efforts as an intern, and now leader in this program have created access to nutrient dense produce for those in need!

LWDI Intern Spotlight: Ivette Receives Grant from Diversify Dietetics!

We are so excited to congratulate Ivette on receiving one of the 2021 Enlightened Grants from Diversify Dietetics to help support her during her Dietetic Internship! Diversify Dietetics works to increase the racial and ethnic diversity in the field of nutrition by empowering nutrition leaders of color.

We are beyond proud to have Ivette in our program. Ivette has big plans on how she will add “something extra” to the world of Dietetics.

Here’s what she has to say about adding her unique and amazing “lagniappe” as a future RDN:

After practicing as a registered dietitian nutritionist, I would like to focus on more community-based programs to improve health outcomes. I plan to develop a ‘food intelligence’ initiative in black and brown communities. There is a lack of supermarket dietitians in less populated lower-income neighborhoods. Supermarket chains like Acme or Shoprite typically have an in-house dietitian. Yet, some black and brown neighborhoods that could benefit from having health and nutrition experts are not afforded equitable services than their more affluent counterparts. In collaboration with two registered nurses, we aim to allocate our healthcare expertise to communities that do not have nutrition education resources readily available. We intend to even out the playing field for people of color. We see incentives in these communities to improve individuals’ professional, financial, and academic outlooks, but there is a lack of investment in individuals’ health and overall well-being. Ideally, this would become a full-time career after becoming well-versed in charitable organizations and funding. The knowledge I will gain from graduating from the Lagniappe Wellness Dietetic Internship will provide a solid foundation as a registered dietitian and diabetes educator as I move forward in this career endeavor.

Ivette, Lagniappe Wellness Dietetic Intern

LWDI Alum Spotlight: Kim lands a position at the National Diabetes & Obesity Research Institute!

Kim has landed a position with the National Diabetes & Obesity Research Institute on their team of amazing Dietitians!

LWDI’s unique affiliation with NDORI allowed Kim to intern on-site with their team. We are beyond proud of her for being offered this valuable and important position to help lead the charge in Diabetes & Obesity prevention and treatment.

Please join us in congratulating Kim on her accomplishment!